Intervention to Promote Positive Parenting and Sensitive Discipline) (0-6 yo) Youth institute (Bakermans- Kranenburg et al., 2017)
Aim to improve discipline strategies of parents, with the goal of promoting positive interactions between parents and infant/child and preventing or reducing behavioural problems of the infant/child.
Parents with problems regarding sensitive nurturing or setting limits, resulting in problems in the parent-infant/child relationship and (an increased risk of) externalizing behavioural problems in the infant/child.
VIPP-SD is performed at home by trained VIPP-SD educators in seven visits of approximately two hours per visit. (Ortho) pedagogues,
psychologists, (social psychiatric) nurses, social workers,
sociotherapists, pedagogical staff, consultation office staff, child psychiatrists or behavioural scientists could provide the intervention
VIPP-SD has the following structure: 1. Introduction and information about the way of working with video feedback; 2. Attachment and exploration and distracting, explaining, giving alternatives and showing understanding; 3. "Speaking for the child" discipline: procrastination and positive reinforcement (compliments); 4. "Sensitivity chain" and sensitive timeout; 5. Sharing feelings and explaining and showing understanding; 6 & 7. Repeat the above topics Proven to be effective to strong indications 2.VoorZorg (0-2 yo) Youth institute (Crijnen et al., 2015)
Aim is to reduce the risk of child maltreatment of a specific target group of high-risk pregnant woman and to increase the developmental and health opportunities of (unborn) infants
(Expectant) mothers and their (unborn) infants, who are confronted with risk factors, such as abuse and neglect, such as low education level, domestic violence, substance use in pregnancy, limited affective and pedagogical skills
VoorZorg consists of structured and flexible home visits, which starts during pregnancy (week 13-16) and finish when the infant is two years old. The home visits are originally twice a month, but in the first six weeks after birth the home visits are on a weekly basis. In total, 40-60 home visits are conducted by the VoorZorg-nurse.
The following six domains are used to educate mothers: 1. Health of the mother (healthy lifestyle, healthy nutrition, stress-reduction); 2. Healthy environment (home situation, safety); 3. Life of the mother (self-reflection, education and job situation); 4. Motherhood (care, attachment, game and exemplary behaviour); 5. Family and friends (supporting social network) and 6. Use of community-services.
Proven to be effective according to good indications
3.ITGG (Integratieve Therapie voor Gehecht heid en Gedrag, 0-18 yo)
Youth institute
(Sterkenburg, 2013)
Aim is to reduce behavioural problems and to (re)build the attachment relationship between parents and infant/child
Infants/children with multiple problems such as: severe mental impairment and behavioural attachment problems, in which pathogenic care is desired. Parents are involved in the intervention.
ITGG consists of three sessions of one hour a week and is offered in the daily living environment of the infant/child, in a place with few ambient noises and where the child feels safe and comfortable. Primary caregivers support the infant/child during the treatment period of one year.
ITGG is a psychotherapeutic treatment that consists of three phases: 1. Building an attachment relationship and is made up of three sub- phases: "bonding and making contact", "symbiosis" and "stimulation to individuation."; 2. Behavioural therapy and; 3. Generalization and completion, involving parents and supervisors.
Proven to be effective according to first indications 4.Ouder-baby interventie (0-1 yo) Youth institute (Nikken, 2009)
Aim to improve the interaction between depressive mothers and their infant, in which the mother improves her sensitive responsiveness, the social and emotional development of the infant improves and the secure parental attachment is ensured
Depressive mothers and their infant
Ouder-baby interventie consists of accompaniment of the family in the home situation, during 8 to 10 home visits of 1 to 1½ hours. The partner and important others are involved in counselling as much as possible. The counselling is provided by a social psychiatric nurse from the mental health care institution, who specializes in counselling families with young children.
Ouder-baby interventie consists of three phases: Phase 1 (1-2 visits): Introduction, motivating the mother, explanation about the guidance and first observation of the mother-baby interaction. Phase 2 (4-6 visits): Empowering and expanding positive interactions between mother and child, stimulating new interactions. Phase 3 (1-2 visits): Review, evaluation and conclusion.
Proven to be effective according to first indications
58 5. Stevig Ouderschap Youth healthcare centre (Bouwmeester- Landweer, 2017)
Aim to reduce the risk of parenting problems among parents at risk of these problems (parents with low social support, psychosocial problems, drug/alcohol use, negative feelings towards pregnancy, problematic history and/or a preterm child or child with low birthweight)
Parents with problems such as low social support, psychosocial problems, drug/alcohol use, negative feelings towards pregnancy, problematic history or preterm born infant or low birthweight of the infant
Stevig Ouderschap consists of four prenatal and 6-10 postnatal home visits duration of 90 minutes per visit, planned in consultation with the parents. The home visits consist of a fixed and flexible part.
Fixed part: following topics are discussed: history of the parents, experience of parenthood, expectations towards the development of the child, social support and professional support. Information is given about the different developmental stages of children and the corresponding specific parenting tasks. Flexible part: client-centred. Empowering experiences as well as worrisome experiences are addressed by the parents
Proven to be effective according to first indications 6.NIKA (0-6 yo) Youth institute (Draaisma, 2014)
Aim to prevent or reduce physical and behavioural problems of the infant/child as a result of disoriented attachment
Families with maltreatment, neglect, domestic violence and/or multiple risks in the parenting context whereas the parent shows "disruptive parenting behaviour" that is confusing or frightening for infants/children
NIKA is a briefly recorded cognitive behavioural therapy intervention that uses video feedback. In total, six sessions at the home situation. The CHC professionals that provide the intervention are behavioural scientists (psychologists or orthopedagogues)
NIKA consists of four phases: 1. Introduction including a pre- measurement; 2. Intervention sessions, weekly recording and discussing about the video observations; 3. Post-measurement and 4. Conclusion and discussing the results.
Well substantiated
7.Shantala babymassage (0-1 yo)
Youth institute
(Roeland & de Lange, 2015)
Aim to reduce the risk of an unsecure attachment relationship and promoting a secure attachment relationship between mother and infant/child, by increasing the sensitivity of the mother during the care of the infant
Mothers who experience problems or stress in the care of the baby or parenthood, and mothers where there are signs of interaction problems between the mother and her infant, such as mothers with a crying infant or an irritable infant
Shantala babymassage consists of parenting education and three home visits of 1,5 hour that occur on a weekly basis. During the intervention, the needs of the mother are placed central.
Topics that are related to the care of the infant are discussed. These are the topics of crying, body language and basic communication. Other topics are the needs of the mother. The mother also gets the space to ask (educational or care) questions. The teacher addresses these questions and, if necessary, refers the mother to other professionals. Well substantiated 8.K-VHT (Kortdurende Video- Hometraining) (0-4 yo) Youth institute
(Eliens & Prinsen, 2017)
Aim to improve the socio-emotional development of infants, by improving contact between parents and infant and thereby preventing or reducing problem behaviour.
Parents who experience parenting tensions. This concerns infants who cry a lot or infants with a difficult temperament. Also, premature infants and toddlers with difficult behaviour are included
K-VHT consists of eight home visits and in these home visits short videos are recorded. The video recording is reviewed with the parents, with the focus on the infant's initiatives to make contact with the parents
During the home visits, video tapes are recorded and reviewed. Pedagogic information is provided, such as diverse communication skills.
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9.3 National preventive parent education interventions that use the factors of secure parental attachment Each national preventive parent education intervention was analysed based on the determinants of Belsky (1984) and then on the causal model consisting of the sixteen factors of parental attachment of Pepers (2019). The results of the analysis and justification of the analysis can be found in and below Table 17.
Table 17:National preventive parent education interventions that used factors of secure parental attachment
Which preventive parent education interventions use the factors of secure parental attachment
VIPP- SD Voorzorg ITGG Ouder-baby interventie Stevig ouderschap NIKA Shantala babymassage K-VHT Individual characteristics mother/father 1.Mental health X X 2.Childhood history X X 3.Representation of (unborn) infant X X X 4.Planning of pregnancy 5.Number of pregnancies 6.Breastfeeding 7.Bedsharing 8.Age X 9.SES/Education X 10.Hormone composition Individual characteristics of the infant 11.Infant temperament X X X X X X X X 12.Preterm birth X Contextual sources of stress and support 13.Marital relationship X X 14.Parenting stress X X X X X 15.Household size 16.Job situation X Total: N=5 N=4 N=2 N=3 N=2 N=1 N=2 N=3
Eight national preventive parent education interventions were analysed to investigate whether or not the intervention addressed the factors of secure parental attachment.
• VIPP-SD intervention
Three factors of secure parental attachment were addressed in this intervention (Bakermans- Kranenburg et al., 2017). Regarding the individual characteristics of the mother/father, the factor ‘representation of (unborn) infant’ was addressed in the intervention by increasing the knowledge of the parents about parenting behaviours in general and the development of infants/toddlers. Also, the ability of parents to show empathy towards their infant was an important aspect. Regarding the individual characteristics of the infant, the factor ‘infant temperament’ was addressed by increasing the observational capabilities of parents and to foster adequate parenting skills by means of sensitive responsiveness. The attitudes of parents are questioned and with the use of the video’s parents learn how to cope with their infant/toddler. Regarding the contextual sources of stress and support, the factor ‘parenting stress’ was addressed by the intervention. With the use of the video-feedback sessions, parents learn about parenting difficulties.
• Voorzorg
Nine factors of secure parental attachment were addressed in this intervention (Crijnen et al., 2015). Regarding the individual characteristics of the mother/father, the intervention addressed the factor ‘mental health’ by aiming attention at the health of the mother. Psychical problems such as depression and anxiety are risk factors for parenting problems and for a job or education. Voorzorg
60 does not treat any psychical problems, but talks about the problems and refer if possible, to specialized medical assistance. The factor ‘childhood history’ was addressed by talking about the youth of the mother. Together with the mother, work is done on awareness of one's own upbringing and the influence that this could have on the upbringing of the child. From this strengthened awareness, the mother can take more distance from her own childhood and deal with her child in a more positive way. The factor ‘representation of (unborn) infant’ was addressed by focussing on the role of the mother as a primary upbringing parent. Situations were practiced were parents must apply parenting skills. Besides, unrealistic expectations of the pregnancy and motherhood were discussed by focussing on information about a healthy pregnancy and by talking about expectations about the upbringing of an infant. Furthermore, the unadaptable factors ‘SES/education’ and ‘age’ were addressed in this intervention since this intervention was especially designed for (expectant) mothers who are aged below 25 years old and their education level was low or they did not finish any education. The SES was addressed by talking about the financial situation of (expectant) mothers.
Regarding the individual characteristics of the infant, the intervention addressed the factor ‘infant temperament’ by talking about the health of the infant and by generating a more sensitive and responsive parenting style in which the relation, the communication and playing with the infant was discussed.
Regarding the contextual sources of stress and support, the intervention addressed the factor ‘parenting stress’ by talking about possible violence, abuse or neglect and to assist mothers by the living- and financial situation. The factor ‘marital relationship’ was addressed by talking about a supportive network of a partner, family and friends. The topic received attention by practical exercises in the home situation, for instance how you deal with disagreements within your social network. The factor ‘work situation’ was addressed by talking about the personal development of the mother, thus by searching for a job. The lack of a basic qualification and/or daytime activities (education/work) have far-reaching financial and emotional consequences. Through awareness sessions, the mother was supported by thinking about an education or job.
• ITGG
This intervention was developed for infants/toddlers/children with multiple problems (Sterkenburg, 2013). This means that this intervention addressed the factor ‘infant temperament’, in which the intervention tried to treat serious problem behaviours of infants by rebuilding the attachment relationship between the infant and the parents or primary caregiver.
• Ouder-baby interventie
In this intervention, two factors of secure parental attachment were addressed (Nikken, 2009). Regarding the individual characteristics of the mother, this intervention addressed the factor ‘mental health’, since this intervention is especially developed for depressive mothers. The intervention addressed this factor by cognitive restructure. Depressive mothers often think negatively about themselves as mothers but also about their child. An explanation was given that these thoughts maintain and sometimes even reinforce depressive feelings. With the help of techniques from cognitive therapy, an attempt is made to restructure the negative thoughts and to convert them into a more positive way of thinking. Regarding the individual characteristics of the infant, the intervention addressed the factor ‘infant temperament’ by advising the mother about how to cope with infants who cry a lot or experience sleeping or eating problems. There was no factor addressed focused on the contextual sources of stress and support.
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• Stevig Ouderschap
In this intervention, five factors of secure parental attachment were addressed (Bouwmeester- Landweer, 2017). Regarding the individual characteristics of the mother/father, the factor ‘childhood history’ was addressed by talking about the parent’s own childhood and development history in which this could prevent transgenerational transfer. The factor ‘representation of (unborn) infant’ was addressed by discussing the process and experiences of the pregnancy and by providing tips for expectant parents to prepare for parenthood. Regarding the individual characteristics of the infant, the intervention addressed the factor ‘infant temperament’ by supporting and advising the parent about the behaviour of the infant. Regarding the contextual sources of stress and support, the factor ‘marital relationship’ was addressed by discussing the support of the social network including the relationship between the parents themselves. The factor ‘parenting stress’ was addressed in the intervention by talking about moments of stress and how the parents could prevent the moments of stress.
• NIKA
This intervention focused on the individual characteristics of the infant. The intervention targets mothers with young infants/toddlers who experience difficulties by sensitive parenting and upbringing skills (Draaisma, 2014). The factor ‘infant temperament’ was addressed in this intervention by showing signals of infants and how to react on these signals. With the use of videos, the mother sees her own negative disruptive parenting behaviour and with psychoeducation this behaviour was discussed and adjusted.
• Shantala babymassage
In this intervention, two factors of secure parental attachment were addressed (Roeland & de Lange, 2015). Regarding the individual characteristics of the infant, the factor ‘infant temperament’ was addressed by assisting the mother or father to recognize signals of the infant and to be more aware of these signals. Regarding the contextual sources of stress and support of parents, the intervention addressed the factor ‘parenting stress’ by focussing on topics that lead to parenting stress. The professional handles topics that parents mention themselves during the home meetings. There was no factor addressed focused on the individual characteristics of the mother/father.
• K-VHT
This intervention addressed three factors of secure parental attachment (Eliens & Prinsen, 2017). Regarding the individual characteristics of the infant, the intervention addressed the factor ‘infant temperament’ by focussing on infants with a difficult temperament or who cry a lot. The target group also includes premature born infants (the factor ‘preterm birth’) and toddlers with difficult behaviour and children who have problems with eating, sleeping and toilet training. K-VHT focused on the parents of these children. Regarding the contextual sources of stress and support, the factor ‘parenting stress’ was addressed in this intervention by talking about everyday parenting difficulties. With the use of videos, parents could learn of difficult situations, situations when they experienced stress, and improve their parenting behaviour and skills. There was no factor addressed focused on the individual characteristics of the mother/father.
9.4. Invitation and information letter for participants (in Dutch) 9.5 Informed consent (in Dutch)
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